Open AccessUnsolved Questions in Salvage TIPSS: Practical Modalities for Placement, Alternative Therapeutics, and Long-Term Outcomes
Author(s) -
Charlotte Bouzbib,
Philippe Sultanik,
Dominique Thabut,
Marika Rudler
Publication year - 2019
Publication title -
canadian journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.921
H-Index - 65
eISSN - 2291-2797
pISSN - 2291-2789
DOI - 10.1155/2019/7956717
Subject(s) - medicine , transjugular intrahepatic portosystemic shunt , liver transplantation , salvage therapy , hepatic encephalopathy , cirrhosis , surgery , concomitant , portal hypertension , transplantation , chemotherapy
Salvage transjugular intrahepatic portosystemic shunt (TIPSS) has proven its efficacy to treat refractory variceal bleeding for patients with cirrhosis. However, this procedure is associated with very poor outcomes. As it is used as a last resort to treat a severe complication of cirrhosis, it seems essential to improve our practice, with the aim of optimizing management of those patients. Somehow, many questions are still unsolved: which stents should be used? Should a concomitant embolization be systematically considered? Is there any alternative therapeutic in case of recurrent bleeding despite TIPSS? What are the long-term outcomes on survival, liver transplantation, and hepatic encephalopathy after salvage TIPSS? Is this procedure futile in some patients? Is prognosis with salvage TIPSS nowadays as bad as earlier, despite the improvement of prophylaxis for variceal bleeding? The aim of this review is to summarize those data and to identify the lacking ones to guide further research on salvage TIPSS.